Cuban Medicine and Biotechnology (1881+) – History of Science in Latin America and the Caribbean

Working fourteen hour days for the equivalent of about twenty USD a month, Cuban scientists are producing a diverse array of genetically engineered drugs, vaccines, and agricultural products that are becoming increasingly popular in international markets. Since the early 1980s, when Cuba sent scientists to Helsinki to acquire the knowledge and equipment to found its own biotechnology industry focused on the new wonder drug interferon, the major thrust of all Cuban science research and development (and funding for science) has been towards this one field. Cuba's perpetual shortages of gasoline, basic medicines, and food, due in part to the U.S. trade embargo in place since 1962, makes their achievements in this cutting-edge field of research all the more remarkable. Yet it is the embargo itself that has provided the impetus for advanced scientific development; Cuba has used biotechnology to create a profitable export that decreases their economic dependency on commodities (like sugar and tobacco) and also to develop new bio-fertilizers and bioengineered crops that allow for increased food production.

Long before the rise of biotechnology, Cuba had a significant impact on tropical medicine and healthcare in general. Cuba's most famous medical project was Carlos Juan Finlay's late nineteenth century inoculations against yellow fever (see the source on Finlay), and primary care has been a point of emphasis since Castro's communist government took power. In 1965, Cuba began a concerted effort to train researchers in advanced scientific techniques, and though it is very rare for a poor developing country to devote so much money to scientific growth, Cuba's efforts proved successful. The National Center for Scientific Research (CENIC) had only twelve scientists in 1965; by 1989, one out of every two hundred and fifty Cubans worked in the sciences.

Cuba's healthcare system prides itself in providing primary and community care to the entire population free of charge. Although the collapse of the U.S.S.R. caused a brief collapse in its ability to provide healthcare, the industry had recovered well by the late 1990s. It is now estimated that 99.2% of Cubans have access to free primary care, a remarkable feat for a country still ranked among the world's developing nations. Complementing domestic healthcare, Cuba specializes in treating various diseases that tend to affect people in developing tropical countries; vitiligo and blindness are two such maladies addressed in this topic's sources. Cuba's medical specializations, offered at affordable prices on a tropical island, have given rise to a significant health tourism industry, a substantial source of Cuban revenue.

Furthermore, Castro's government continues to invest heavily in biotechnology. From 1990-1996, the government put about one billion USD into scientific research, much of which went towards the creation of "Scientific Poles," most notable of which is the Western Havana Bio-Cluster, a sort of Silicon Valley for biotechnology. The Bio-Cluster has fifty-two institutions that facilitate over one hundred research projects aimed at creating new products to export, including vaccines and treatments for AIDS, Alzheimer's, cholera, and hepatitis.

Among the institutions in the Bio-Cluster are the Center for Genetic Engineering and Biotechnology (CIGB) and the Finlay Institute. The vaccines produced by the CIGB have made hepatitis-B disappear among Cuban infants and scientists expect to soon end the circulation of the disease all together. It also has developed advanced (more resistant) strains of staple crops and Acuabio-1, a product that improves the growth and survival rates of farmed fish. In 2006, the CIGB created the first drug to treat and cure diabetic foot ulcers, the leading non-traumatic cause of lower-leg amputations. The Finlay Institute was created in 1994 at a cost of ten million USD and, in 1999, it produced the world's first vaccine against meningitis B. The vaccine was created by Concepcion Campa Huergo, now the president and director of the Institute, who tested it on herself and her children before experimenting on volunteers.

Despite such innovations, perpetual funding shortages have limited Cuba's ability to conduct pure research, focusing instead on the products that are known to be profitable and/or publicly beneficial. In communist Cuba, where the direction of scientific development follows a top-down hierarchy and limits independent innovation by individual scientists, Castro's government has ultimate control over what drugs and bioengineered crops Cuba tries to produce. This emphasis on useful knowledge applied to immediately functional purposes has been a recurrent characteristic of Latin American science since the colonial period.

Nevertheless, Cuba's goal is to produce practical, profitable, and beneficial innovations that will help the Cuban economy as well as fulfill a humanitarian mission and, thanks to innovations like Huergo's hepatitis vaccine, the venture has been an overall success. Cuba is also is the largest exporter of medicine in all of Latin America, bringing in over 100 million USD from about fifty client nations like Brazil and Russia. Furthermore, Cuba takes pride in working to prevent and treat the maladies that plague much of the undeveloped world, such as AIDS and tropical diseases, while many of the biggest drug companies in the United States focus their efforts on profitable though non-humanitarian products, like cures for baldness. The tenets of Cuba's revolution--humanity, solidarity, sacrifice, and toughness--are still very much alive in its medical and biotechnology enterprises.

Questions for further exploration:

Although Castro first initiated Cuba's biotechnology program in 1980, when it could still export its medicines to nations of the Soviet bloc, the industry became even more central to Cuban science in the so-called "special period" following the collapse of the Soviet Union in 1991. Why, despite the extreme economic hardships that were placed on Cuba in the early 1990s, did they devote even more money to their biotechnology industry? (answers could include economics, humanitarian benefit, national image/pride, top-down policy decisions, useful knowledge, etc.)
The trade embargo with the United States not only prevents food and other products from being traded to Cuba, but it also limits the amount of intellectual exchange between Cuban scientists and the international scientific community (e.g. by forbidding Cubans to travel to conferences in the U.S.). Do the restrictions placed on Cuba stymie its medical and biotechnology industries, preventing them from reaching their potentials, or does the embargo actually provide Cuba with the impetus to excel in these areas?
Compare Cuba's biotechnology industry to Brazil's nuclear projects. Are the motivations of these two countries comparable? How have their efforts been received worldwide? Overall, which country's industry has been more successful at achieving its goals?
Now that Castro is in his last years and the fate of communism in Cuba is very uncertain, what do you think would happen to its healthcare system if Cuba joins the larger capitalist world economy? Would it improve the quality and availability of primary care?

Further Reading:
Claudio, Luz. "The Challenge of Cuba." Environmental Health Perspectives. 107: 5 (May 1999): A246-A251.

Feinsilver, Julie M. "Cuban Biotechnology: The Strategic Success and Commercial Limits of a First World Approach to Development." In Biotechnology in Latin America: Politics, Impacts, and Risks. Ed. N. Patrick Peritore and Ana Karina Galve-Peritore. Wilmington: Scholarly Resources Inc., 1995.

Feinsilver, Julie M. Healing the Masses: Cuban Health Politics at Home and Abroad. Berkeley: University of California Press, 1993.

Kaiser, Jocelyn. "Cuba's Billion Dollar Biotech Gamble." Science, New Series. 282: 5394 (November 1998): 1626-1628.

Nayeri, Kamran and Candido M. Lopez-Pardo. "Economic Crisis and Access to Care: Cuba's Health Care System since the Collapse of the Soviet Union." In International Journal of Health Services. 35: 4 (2005): 797-816.

Stepan, Nancy. "The Interplay Between Socio-Economic Factors and Medical Science: Yellow Fever Research, Cuba, and the United States." Social Studies of Science. 8: 4 (November 1978): 397-423.

Agricultural Research in Cuba

Date: 1991
Owner: Adam Jones
Source Type: Images

Since the 1960s, Cuba has made an effort to increase domestic agricultural yields and thus lessen its dependency on food imports. In 1991, after the fall of the U.S.S.R., the Fourth Congress of the Communist Party of Cuba made it a priority to use biotechnology to augment Cuba's capacity to feed itself. Cuban scientists have created new biofertilizers, new strains of crops, and new animal vaccines that have greatly decreased their reliance on imports. Rhizobium bacterium is a biofertilizer that promotes nodulation and nitrogen fixation in legumes, producing plants that are 30-70% larger and nourish the soil as they grow. This fertilizer helped facilitate the mass production of Cubasoy 23, a soybean that can fully develop in about 100 days. Biofactories in Cuba also mass produce in vitro seedlings for crops like sugarcane, potatoes, and plantains, eliminating the need to import seeds. Genetic engineers isolated the gene in cows that causes hemorrhagic bovine disease and used it to create a vaccine that would help protect their livestock. Since 1991, biotechnology has enabled Cuba to import far less food and fertilizer, thus strengthening their economy and improving the health of its people.

CITATION: Dr. Adam Jones. Tobacco field near Vinales, Cuba. December, 2006.
DIGITAL ID: 12750

Carlos Juan Finlay

Date: c. 1900
Owner: Wikimedia
Source Type: Images

Cuban physician and epidemiologist Carlos Juan Finlay (1833-1915) discovered that yellow fever was transmitted by mosquitoes and that mosquitoes could also be used to inoculate people against the disease. He presented this theory in 1881 at the International Sanitary Conference in Washington, D.C., yet few scientists or physicians believed him. From 1881 to 1900, Finlay conducted 102 inoculations on volunteers and considered the results as proof of his theories. Although the experiments gave him more credence, many physicians thought that his volunteers were exposed to too many different variables, thus skewing Finlay's results. His hypothesis was not generally accepted until 1900, when Dr. Walter Reed carried out a series of controlled experiments at Camp Lazear to determine whether yellow fever was transmitted by contact, as many believed, or by mosquitoes.

It is interesting to note that despite Finlay's incredible scientific achievements, his motivation was not altogether altruistic by modern standards. In the late nineteenth-century, Cuba encouraged white immigration, partially because they thought it would help to modernize the country and partially due to traditional fears that blacks and mestizos would assume too much clout in Cuban society. Yellow fever, however, was most devastating to new immigrants and the high mortality rates deterred many whites who may otherwise have moved to the island. Finlay's focus on yellow fever was thus catalyzed by social influences that, like many such measures in late nineteenth-century Latin America, were concerned with issues of race.

Reference:

Stepan, Nancy. "The Interplay Between Socioeconomic Factors and Medical Science: Yellow Fever in Cuba and the United States." Social Studies of Science. 8 (1978): 297-424.

CITATION: Carlos Juan Finlay, Cuban Physician. Courtesy of WikiMedia Commons, http://commons.wikimedia.org/wiki/File:Finlay_Carlos_1833-1915.jpg.
DIGITAL ID: 12746

Cuban Medical Students

Date: 2011
Owner: Granma
Source Type: Images

This photograph shows a classroom lecture in Havana's Latin American School of Medical Sciences (ELACM). This medical school, which now has an enrollment of about 4000 students, offers free education and free room and board to an elite corps of students from throughout the developing world. ELACM even offers free Spanish lessons for students from non Spanish speaking countries. Building off of Latin American traditions of applied science, the first two years of the six year curriculum emphasize a hands-on, work-focused approach to learning that teaches the broad range of skills needed to provide primary care. Due to Cuba's efforts to provide for the needs of women and children, community health, obstetrics, and gynecology are given special emphasis. After finishing the two years of general study, students spend the next four years developing a specialization.

The collapse of the Soviet Union caused a dramatic decline in health among Cubans. The per capita caloric intake dropped by almost 40% and little funding was available to support the infrastructure of Cuba's primary care system. Yet, despite the fact that the U.S. augmented its trade embargo, the economy--and especially the nation's healthcare services--have recovered rather well. Between 1990 and 2003, the number of primary care physicians increased by 76% and, due in large part to agricultural biotechnology, the average Cuban's diet has become quite healthy (Nayeri and Lopez-Pardo 2005). By emphasizing that students from the developing world (who would not be able to afford medical school in the U.S.) receive a quality, work-oriented medical education, Cuba is furthering its humanitarian healthcare mission.

CITATION: Cuban medical school class. Image originally published in Granma, the official organ of the the central committee of the Latin American School of Medicine, July 2011.
DIGITAL ID: 12752

Interferon

Date: 1980
Owner: Google Images
Source Type: Images

In the early 1980s, many scientists considered interferon to be a new wonder drug with the potential to treat cancer (this TIME magazine cover is from March, 1980). Interferon is a protein produced naturally by the immune system to combat viruses and bacteria and bioengineers have developed means to produce enhanced versions of this protein by binding it with various molecules. The potential for profit and humanitarian benefit that interferon seemed to promise prompted Fidel Castro to focus Cuba's scientific efforts on biotechnology in order to attain the means to manufacture and market this drug. Thus, in 1981, Cuban scientists traveled to Houston and Helsinki to study the production of interferon and, with equipment purchased from Finland, Germany, and Japan, Cuba soon developed a significant interferon industry. By 1986, Cuba was the world's second leading producer of the human leukocyte interferon and the knowledge gained from its development provided the foundation for its biotechnology industry to expand, especially in the creation of other bio-engineered treatments and vaccines. Although interferon was discredited as a wonder drug for cancer, production has continued in Cuba because of several newly discovered applications. The recombinant alpha 2B interferon, one of the major products of Cuba's biotechnology centers, has proven effective at halting the progress of AIDS in HIV positive patients who have yet to show any symptoms.

CITATION: "TIME Cover: 03-31-1980 on Interferon." Photographer: Henry Grosinski. Courtesy of Google Images.
DIGITAL ID: 12855

Operation Milagro

Date: 2011
Owner: Mesa Redonda
Source Type: Images

A group of doctors providing eye care through Operacion Milagro, a project dedicated to restoring vision to the sight deprived. Begun in 2004 as a joint venture between Castro's Cuba and Hugo Chavez's Venezuela, Operacion Milagro treats the main causes of blindness in developing nations, where sight deprivation is almost four times more common than in the first world. The main causes of blindness in Latin America are cataracts, vitamin A deficiency, glaucoma, diabetic retinopathy, and various infectious diseases.

Operacion Milagro exemplifies communist Cuba's goals for humanitarian aid and solidarity throughout the developing world. The island nation has donated thirty seven opthalmological centers to eight different countries in the Caribbean, Latin America, and Africa that, between them, have treated over 750,000 patients. Cuban officials estimate that one out of every seventy eight Cubans has benefited directly from this program. Despite the U.S. trade embargo, Cuba has committed many of its resources to providing specialized health services that compliment its extensive primary care institutions. This emphasis on expert treatment for various specific ailments has provided an affordable means by which many people in the developing world--who would be excluded from capitalist medical systems--have the opportunity to be healed

DIGITAL ID: 12747

Source References

Web Sites
Cuba Organic Support Group (Cuba Organic Support Group)

Publications
Claudio, Luz. "The Challenge of Cuba." Environmental Health Perspectives. 107:5 (May 1999): A246-A251.

Feinsilver, Julie M. Healing the Masses: Cuban Health Politics at Home and Abroad. Berkeley: University of California Press, 1993.

Guttmacher, Sally and Ross Danielson. "Changes in Cuban Health Care: An Argument Against Technological Pessimism." International Journal of Health Services. 7: 3 (1977): 383-400.

Horn, David G. The Criminal Body: Lombroso and the Anatomy of Deviance. New York: Routledge, 2003.

Kaiser, Jocelyn. "Cuba's Billion Dollar Biotech Gamble." Science, New Series. 282: 5394 (November 1998): 1626-1628.

Nayeri, Kamran and Candido M. Lopez-Pardo. "Economic Crisis and Access to Care: Cuba's Health Care System since the Collapse of the Soviet Union." International Journal of Health Services. 35: 4 (2005): 797-816.

Orrego, Cristian. Excellence under adversity: The life sciences and biotechnology in Latin America and the role of scientific societies in their development. Caracas: Interciencia Association, 1989.

Peritore, Patrick and Ana Karina Gave-Peritone. Biotechnology in Latin America: Politics, Impacts and Risks. Wilmington, DE: Scholarly Resources, 1995.

Schwab, Peter. "Cuban Health Care and the U.S. Embargo." Monthly Review. 49: 6 (1997): 15-26.

Singer, Peter A. and Abdallah S. Daar."Harnessing Genomics and Biotechnology to Improve Global Health Equity" Science, New Series. 294: 5540 (2001): 87-89.

Stepan, Nancy. "The Interplay Between Socioeconomic Factors and Medical Science: Yellow Fever in Cuba and the United States." Social Studies of Science. 8 (1978): 297-424.

Waitzkin, Howard. "Health Policy and Social Change: A Comparative History of Chile and Cuba." Social Problems. 31 (1983): 235-248.

Williams, Eric. From Columbus to Castro: The History of the Caribbean 1492-1969. New York: Vintage, 1984.

Treating Vitiligo in Cuba

Date: 2006
Owner: Matarese
Source Type: Images

The Tarara Hospital in Havana, Cuba, specializes in the treatment of vitiligo, a skin pigment disorder that--though found worldwide--is most common in the tropics. In the mid 1970s, Cuban Ob/Gyn Carlos Miyares Cao discovered a substance in the human placenta which stimulates pigmentation, and he soon realized that it cured the symptoms of vitiligo. By the mid 1980s, Cao had treated over 800 cases of vitiligo from twenty four countries (including a large number of Brazilians) and, in 1985, he became the director of the world's first center for vitiligo treatment, the Cira Garcia Clinic. This clinic was among the first institutions that gave rise to Cuba's health tourism industry, which attracts people to the island from all over the world for affordable treatments. 1986 saw the construction of the Placental Histotherapy Center (also directed by Cao), which manufactured several products from placental chemicals including Melaginina (the vitiligo medicine), dietary supplements, and even cosmetics and shampoos. Perhaps more importantly, Cuba's emphasis on this ailment raised global awareness, spawning support groups and clinics for people with a disease that had hitherto been widely ignored in the U.S. and Europe (Feinsilver 1993).

Although vitiligo is just one of several maladies that resulted from the Chernobyl disaster, Cuba has provided medical treatment (and a tropical getaway) to patients affected by its radiation. The Tarara Hospital pictured here has helped over twenty thousand persons poisoned by Chernobyl, most of them children.

CITATION: Tarara Hospital in Havana, Cuba. Matarese.com.
DIGITAL ID: 12970

Yellow Fever Patients in Cuba